Initial Application For Assessment For A Two Component Star Rated License Form - North Carolina Department Of Health And Human Services
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1
2North Carolina Department of Health and Human Services
Pat McCrory
Richard O. Brajer
Governor
Secretary
Pamela L. Shue, Director
Child Development and Early Education
TO:
Family Child Care Home Operators
Thank you for your interest in participating in North Carolina’s Star Rated License System. This information includes an Initial
Application for Assessment for a Two Component Star Rated License and instructions to get the rated license assessment process
started.
First, complete the Initial Application for Assessment for a Two Component Star Rated License. This completed application, along with
other supporting documentation, should be submitted directly to your child care licensing consultant. Please follow the instructions
below when completing the application.
Part I
Education Standards
Use the Education Standards section to record all your experience and education. Complete the NC DCDEE Child Care Providers
Education and Equivalency Form for FCCH Providers and submit this form to the Education Workforce Unit within the Division of Child
Development and Early Education along with original college transcripts. This form is located on the Division’s website under Provider
Documents at this link:
Part II Program Standards
Check all boxes that apply to your family child care home. You must develop written Operational Policies in order to qualify for more
than one point in program standards. If you are applying for three through seven points, a Family Child Care Environment Rating
Scale-Revised (FCCERS-R) will be conducted. Your score on the FCCERS-R assessment will have an effect on the point level you
receive.
Part III Quality Point
You may choose to earn one quality point towards the total points earned on your rated license assessment. In this section, you will
indicate all the quality point options your program meets. During your rated license assessment your child care licensing consultant will
verify your program meets at least one option.
Part IV Required Signature
Sign and date the Application and send the application directly to your child care licensing consultant. In addition, send a copy of your
in-service training log and operational policies, if applicable. Remember to mail your original transcript to the Education Workforce Unit.
For rated license requirements refer to the Voluntary Enhanced Requirements in Section .2800. Contact your child care licensing
consultant, if you have any questions. Your child care licensing consultant will schedule a visit to review all requirements after receiving
your Application and other supporting documentation. After the visit your child care licensing consultant will request for the FCCERS-R
assessment, if needed.
•
Tel 919-527-6335 • Fax 919-715-1013
Location: 820 South Boylan Avenue • Raleigh, NC 27603
Mailing Address: 2201 Mail Service Center • Raleigh, NC 27699-2201
An Equal Opportunity / Affirmative Action Employer
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